Sexual assault, by its very nature, is an intimate crime of the body. Most frequently, this assault reveals the parts of the body that transgender people may feel the most vulnerable, anxious, or sensitive about—namely their chest and genitals and often their face. To decrease bodily discomfort, some transgender people keep these body parts covered, hide them (e.g., through binding, makeup, clothing), and seldom discuss them. Some transgender people may not like or may even abhor the genitals they were born with, viewing them as "birth defects." This can be in part because their gendered body parts are incongruent with their sense of self or may have been used against them by those who sought to oppose, deny, or destroy the person's gender identity or self-esteem. As a result, some transgender people try not to think or talk about their genitals at all, and discussing them with others after a sexual assault can be painful and humiliating.
Sexual assault against transgender individuals is frequently accompanied by hateful epithets or slurs that denigrate the victim's body, gender expression, or existence. For example, FTMs (female-to-males) who bind their chests may have their binders destroyed or their chest specifically targeted for injury, and MTFs (male-to-females) who are sexually assaulted frequently have their faces or genitals cut.
Because of the nature of these types of sexual assaults and the harsh language that might accompany them, it is doubly important that professionals use respectful language that reflects how victims see and talk about their bodies, identities, and experiences.
There are few situations in which it would be appropriate for a professional to discuss a victim's body image or appearance. A solid indicator of appropriateness is to consider whether it would be equally appropriate to comment on or discuss a non-transgender person's body, body image, or appearance. If it is inappropriate to discuss with a non-transgender person, it is equally inappropriate to discuss with a transgender person.
Implications and Actions for ...
Health Care Providers
Some transgender people have a negative body image; they may be so uncomfortable with their chests, for example, that they do not allow health care providers to listen to their heart or lungs during routine exams. Being sexually assaulted may cause transgender patients to shut down and make them unable or unwilling to discuss their bodies during an exam or even be unable to accurately describe bodily sensations/symptoms. In these cases, maintain eye contact, engage the patient verbally, be patient, acknowledge that the topic may be uncomfortable, but ultimately be respectful of a patient's boundaries. As one survivor put it, "The [procedures] are more intrusive if you are uncomfortable with your body in the first place. [Health care professionals] need to understand that."1
Other techniques for reassuring patients with poor body image include the following:
1. FORGE, 2005, Sexual Violence in the Transgender Community Survey, quotation from narrative response, unpublished data.
Emergency Medical Personnel
Some transgender people have a negative body image, so being sexually assaulted may cause them to shut down and make them unable or unwilling to discuss their bodies or the assault. Be respectful of a patient's boundaries.
Some transgender people have a negative body image. Due to this discomfort with their bodies, they may be reluctant to discuss what happened during the sexual assault. Although many survivors have difficulty reporting details of their assault, transgender victims may have the added layer of not wanting to talk about specific parts of their bodies that they feel disconnected to or about which they feel embarrassed or ashamed. This may be especially true, for example, if law enforcement does not know that the victim is transgender and the assault violated a part of the body that is not typically associated with the gender the officer perceives the individual to be.
Some transgender people are unable or unwilling to discuss their bodies because of poor body image. Being sexually assaulted may cause transgender victims to shut down even more. If this is the case, consider using dolls with detailed anatomy. Some transgender patients may find it easier to identify injuries, pain, or assault experiences through these assistive devices. (Offer multiple-gendered dolls, if available.) If needed, offer patients paper and pencils so that they can draw or write if they are unable to articulate or use other means to communicate.
Mental health providers who are helping survivors work through the aftermath of sexual assault need to take extra steps to be sensitive to transgender clients' needs. Be aware that transgender survivors may need your “permission” and extra support before they can talk about how the assault affects how they feel about their bodies and/or gender. Sexual assault may play a pivotal role in how people perceive their bodies and which course they pursue related to gender. It also is critical to determine and reflect the terms clients use to refer to their body and identity. See Preferred Language: Implications and Actions for Therapists in this e-pub for more information.
Support Group Facilitators
Support group facilitators who are helping survivors work through the aftermath of sexual assault need to take extra steps to be sensitive to transgender clients' needs. Be aware that transgender survivors may need your "permission" and extra support before they can talk about how the assault affects how they feel about their bodies and/or gender, especially in a group setting. Sexual assault may play a pivotal role in how people perceive their bodies and which course they pursue related to gender.
Some support group participants may find the complicated stories of some transgender survivors challenging and confusing. Though it is important not to silence a transgender survivor's narrative about body image, you must not let the unique challenges of one survivor take the focus away from other group members or from discussion that benefits most or all in the group. One way to help this process is to draw comparisons between the experiences of transgender and non-transgender group members. Note, for example, how all people have different perceptions about their bodies. Drawing out similarities will help the transgender person feel less isolated and different and will help other group members see how human experiences are just thathuman, not transgender or non-transgender.